TABLE 2.

Recommendations for Clubfoot Bracing Schedules (based on current knowledge)

a. Final correction in the first few months of life

i. Wear brace 23 hours/day for first three months

ii. Follow a gradual weaning schedule*: one month 20-22 hours/day, one month 18-20 hours/day, one month 16-18 hours/day,

and one month 14-16 hours/day

iii. Maintain night-time wearing of the brace (12-14 hours/day) as the child grows and is walking full time for up to age 4-5 years

b. Final correction achieved after 8-9 months of age and child is ready for crawling or walking

i. Allow some mobility to help in the development of the weak muscles.

ii. Begin initial bracing with 18-20 hours/day for 2 months and then 16 hours a day for 3-4 months

iii. Follow standard maintenance protocol (a. iii.)

c. Final correction at age 2 to 4 years of age

i. Use the brace at night as per standard protocol (a.iii)

d. Final Correction after 4 years of age

i. Some patients may still tolerate the brace at night for 1-2 years.

ii. In some patients, the use of an AFO will be more acceptable.

e. Children with loose joints (approximately 2-3% of cases)

i. Set the shoe to 30-40% abduction (abduction of 60 to 70 degrees may lead to flat foot, usually presenting when the patient

starts walking at 10-16 months of age and after)

ii. Do not stop using the brace as there is a risk of relapse.

f.Children with has atypical/complex clubfoot

i. Set the shoe for the affected foot at 20-30 degrees.

ii. Do not bend the bar unless there is 10-15 degrees of dorsiflexion with the last cast.

iii. Change the angle of the shoe to 40-50 degrees as the foot becomes more normal looking and add the bend in the far to

allow 10-15 degrees of dorsiflexion.

^*The time in the brace does not need to be consecutive, but it is important for the child to wear the brace while sleeping (e.g., at night, during naps) to encourage mobility during waking hours. If the child attends daycare, consider leaving the brace on in the morning and instructing the daycare as to what time each day that the brace should be removed. If possible, instruct them how to remove and reapply the brace for nap times.